What is the current status of a 7-year-old patient with severe persistent asthma, who was referred to a pulmonologist (pulm), and is now reporting improvement in symptoms, with no coughing episodes during the day or night?

From the Guidelines

The patient should continue the current asthma controller medication regimen, which likely includes an inhaled corticosteroid (such as fluticasone or budesonide) combined with a long-acting beta-agonist (such as salmeterol or formoterol), as recommended by the expert panel report 3 (epr-3) guidelines for the diagnosis and management of asthma-summary report 2007 1. The patient, a 7-year-old with severe persistent asthma, is showing improvement according to the mother's report, with both mother and child denying any daytime or nighttime coughing. For this follow-up visit after a previous sick visit diagnosis of severe persistent asthma,

• The patient should maintain the prescribed dosing schedule without interruption despite symptom improvement.
• Ensure the patient has a rescue inhaler (albuterol) available for breakthrough symptoms.
• The pulmonology referral should be kept as scheduled, as specialist evaluation is essential for severe persistent asthma management. At home,
• Continue to monitor for any symptom recurrence, particularly nighttime coughing, exercise limitations, or increased rescue inhaler use. The current improvement suggests the treatment plan is effective, but severe persistent asthma requires ongoing management and periodic assessment of lung function to prevent exacerbations and maintain optimal respiratory health, as emphasized in the guidelines 1. Regular follow-up appointments should continue every 1-3 months until stable control is established.

From the Research

Patient Follow-up and Asthma Management

• The patient, a 7-year-old, has been followed up after a previous sick visit where severe persistent asthma was diagnosed, and a referral to a pulmonologist was made.
• The mother reports that the patient is feeling much better, and both the mother and child deny coughing during the day or at night.

Asthma Treatment and Management

• According to 2, inhaled corticosteroids (ICS) are essential for managing mild persistent asthma, and adding a long-acting beta-agonist (LABA) may not be necessary for most patients.
• The study 3 suggests that single inhaler combination regimens, such as budesonide/formoterol, can be more effective in improving treatment outcomes than monotherapy alone.
• For patients with moderate persistent asthma, the combination of an ICS and LABA is preferred, as it can provide better asthma control and reduce exacerbation risks 2.

Treatment Options and Efficacy

• The use of ICS and LABA in combination has been shown to be effective in reducing exacerbations and improving symptoms in patients with asthma 3, 4.
• The study 5 highlights the benefits of single-inhaler triple therapy, which combines an ICS, LABA, and a long-acting muscarinic antagonist (LAMA), in improving respiratory function and reducing exacerbations in patients with uncontrolled asthma.

Considerations for Patient Care

• The patient's response to treatment and any changes in symptoms should be closely monitored to adjust the treatment plan as needed.
• The use of a single inhaler for combination therapy may improve patient adherence and reduce the risk of device mismanagement 5.